Bronx Community Health Dashboard Mental Health Last Updated

Bronx Community Health Dashboard: Mental Health Last Updated: 5/20/2019 See last slide for more information about this project. 1

All together, mental disorders, substance abuse and self-harm & interpersonal violence account for 17% of disability in the US Percent of Total DALYs Cardiovascular Disease Cancer Musculoskeletal Disorders Mental Disorders Neurological Disorders Substance Use Chronic Respiratory Diseases Diabetes, Urogenital, Blood, and Endocrine Diseases Other NCD Unintentional Injuries (Non-transport) Digestive Self-harm and Interpersonal Violence Skin Transport Injuries Sense Organ Disease Maternal & Neonatal Disorders Respiratory Infections and TB HIV/AIDS & STIs 15. 6 14. 7 7. 1 6. 7 6. 6 6. 0 5. 7 billion 17. 1% 4. 0 3. 8 3. 6 3. 4 2. 9 2. 8 2. 3 1. 9 1. 8 Annual cost of depression in the United States (in 2018 dollars) Source: Greenberg et al. , J Clin Psychiatry, 2015. 0. 5 0 2 $248 9. 6 2 4 6 8 10 12 14 16 18 Data source: Global Burden of Disease Project, 2017. DALY stands for disability adjusted life year and is a summary measure of population health status that combines data on mortality and morbidity.

Current Depression 3

Age-adjusted percent reporting current depression The Bronx has the highest prevalence of estimated depression and within the Bronx, females, Hispanic and younger (18 -24) residents have the highest prevalence Bronx only 20 16. 4 15 16. 1 14. 1 13. 4 11. 7 10 9. 8 8. 4 9. 3 12. 7 12. 3* 9. 7 12. 0 8. 8* 7. 7 5 0 Bronx Brooklyn. Manhattan. Queens Staten Island 4 Male Female Data source: New York City Community Health Survey, 2017. Age results are not age-adjusted. *Estimates are unreliable and should be interpreted with caution. Estimated current depression defined as PHQ-9 score≥ 10. Hispanic Non. Hispanic Black White Other 18 -24 25 -44 45 -64 65+

12 9. 5 10 6 4 2 ) 07 06 05 (1 s x og on hr So ut h Br -T am lh Pe rd Fo /1 N ec k nx ro -B N /1 (1 0 3) (1 0 Pk x Br on E rid sb ng 4) 0 Ki 5 Data source: New York City Community Health Survey, 2017 *Estimates are unreliable and should be interpreted with caution. Estimated current depression defined as PHQ-9 score≥ 10. 8. 9 8 ge 105/106/107 South Bronx 14 14 m 104 Pelham-Throgs Neck 14. 2* 2) 103 Fordham-Bronx Pk 16 ha 104 (1 0 102 NE Bronx 105 106 107 16. 9 ) 101 Kingsbridge 18 01 103 102 (1 101 Age-adjusted percent experiencing current depression Bronx neighborhood with the highest prevalence of estimated depression is South Bronx

Serious psychological distress is determined by responses to six questions regarding feeling sad, nervous, restless, hopeless, that everything is an effort and worthless. This tool is called the Kessler 6 inventory. 6

Both the Bronx and the rest of NYC have experienced a decline in the prevalence of serious psychological distress Bronx Excluding the Bronx Serious psychological distress does not reflect a specific symptomology, but is useful for understanding trends 10 Age-adjusted percent experiencing serious psychological distress 9 8. 8 8 7 6. 5 6. 1 6 5. 3 5 4 3 2 1 0 2002 7 2003 2004 2005 2006 2007 2008 Data source: New York City Community Health Survey, 2002 -2015. 2009 2010 2011 2012 2013 2014 2015

Access to mental health services 8

Age-adjusted percent reporting mental health counseling or treatment, amongst those with current depression in past 12 months Among Bronx adults, Hispanic residents that are depressed are least likely to have received mental health counseling or treatment 9 60 Bronx only 55. 0* 37. 6* 47. 8* 40 39. 1 38. 8 41. 2* 40. 9* 36. 5* 40. 7 36. 7* 33. 3* 36. 2* 33. 3 49. 3* 20 0 Bronx Brooklyn Manhattan Queens Staten Island Male Data source: New York City Community Health Survey, 2017. Age results are not age-adjusted. *Estimates are unreliable and should be interpreted with caution. Female Hispanic Non. Hispanic Black White 18 -24 25 -44 45 -64 65+

Percent of youth receiving counseling for an emotional or personal issue in past 12 months Among Bronx youth, female and older youth are more likely to report receiving counseling in the past 12 months Bronx only 30 25. 7 21. 0 20. 4 20 21. 4 10 th 11 th 18. 4 18. 0 14. 8 15. 2 16. 1 14. 5 11. 3 10 0 Bronx Brooklyn. Manhattan. Queens Staten Island 10 22. 8 22. 1 22. 0 Data source: Youth Risk Behavior Survey, 2017 Male Female Hispanic Non. Hispanic Black White Asian 9 th Grade 12 th

In the Bronx, the percent of youth receiving professional help for a personal problem in the past 12 months has been relatively stable since 2013 Percent of youth receiving counseling for an emotional or personal issue in past 12 months 30 Bronx Brooklyn Manhattan Queens Staten Island 25 21. 0 20. 1 20 20. 4 19. 8 18. 0 16. 8 15. 2 15 10 5 0 2013 11 Data source: Youth Risk Behavior Survey, 2013, 2015, 2017 2015 2017

Psychiatric hospitalizations 12

Bronx has the highest rate of psychiatric hospitalizations Rate of psychiatric hospitalizations per 100, 000 adults 900 853 750 707 684 600 513 300 0 Bronx 13 Brooklyn Queens Manhatten Data source: New York State SPARCS data, 2015 reported in the NYC Community Health Profiles, 2018. Staten Island

or ris Age-adjusted rate of psychiatric hospitalizations per 100, 000 Be an lm ia Fo on an rd ta ha d C nd m ro an Ea to na d st U Tr ( ni M em 203 ve ot ) rs t. H on ity H t a (2 un ve H 06 ei n ts g ) an ht Po s d H i n ( M ig 20 ta el hb 5) n r o d rid s L e ge on M or Ki gw (20 a nd ris 1) ng oo sb Pa C d on rid rk (2 co 02 g a e W n u ) d r H illi se Br am eig (2 on ht 04 sb xd s rid ) an a le Pa ge d (2 Be rk an 11 ch df d ) es or B d te ay ( ra 20 ch R nd es 7) iv er te S Th da r( ou ro 21 le nd gs 2) an vi N e d w ec F (2 k an ield 09 st d ) o C n o(2 op 08 C ) ity (2 10 ) In the Bronx, Morrisania and Crotona has the highest rate of psychiatric hospitalizations 1, 600 1, 435 1, 400 1, 200 1, 160 1, 000 201 Mott Haven & Melrose 202 Hunts Point & Longwood 203 Morrisania & Crotona 204 Highbridge & Concourse 205 Fordham & University Heights 206 Belmont & East Tremont 207 Kingsbridge Heights & Bedford 208 Riverdale & Fieldston 209 Parkchester & Soundview 210 Throgs Neck & Co-op City 211 Morris Park & Bronxdale 600 400 200 0 M 212 Williamsbridge & Baychester 800 14 Data source: New York State SPARCS data, 2015 reported in the NYC Community Health Profiles, 2018. 961 940 919 862 769 719 669 612 534 438

Suicide attempts among youth 15

The percent of youth attempting suicide has increased by 62% in the Bronx since 2003 Bronx Brooklyn Manhattan Queens Staten Island Age-adjusted percent (%) of youth attempting suicide once or more during the past year 14 12. 6 11. 5 12 10 10. 2 9. 3 8. 7 8 7. 8 6. 9 7. 3 6 7. 1 4 2 0 2003 16 2005 2007 2009 Data source: New York City Youth Risk Behavior Survey, 2003 -2017. 2011 2013 2015 2017

In the Bronx, suicide attempts are increasing for boys and relatively stable for girls, similar to citywide trends Age-adjusted percent (%) of youth attempting suicide once or more during the past year Bronx Male Bronx Female NYC Male NYC Female 16 14 12 10 8 6 4 2 0 2003 17 2005 2007 2009 Data source: New York City Youth Risk Behavior Survey, 1997 -2017. 2011 2013 2015 2017

In the Bronx, suicide attempts have increased the most for non. Hispanic black youth Non-Hispanic white Age-adjusted percent (%) of youth attempting suicide once or more during the past year 14 Hispanic Non-Hispanic black Asian 12 11. 3 10 9. 5 8. 7 8 8. 6 6 4. 4 4. 9 4 3. 4 2 0 1999 18 2001 2003 2005 2007 Data source: New York City Youth Risk Behavior Survey, 1999 -2017. 2009 2011 2013 2015 2017

Suicide mortality 19

For the Bronx and the rest of NYC, the suicide mortality rate has remained stable and much lower than the US overall U. S. overall Bronx NYC, excluding the Bronx 14. 0 14 12 10 8 6. 2 5. 9 6 5. 5 5. 3 4 Age-adjusted mortality rate from suicide per 100, 000 in 2017 10 8. 3 8 6 7. 5 5. 3 Bx Bk 5. 6 4 2 2 0 20 Data source: Underlying Cause of Death, 1999 -2017. 20 17 20 16 20 15 20 14 20 13 20 12 20 11 20 10 20 09 20 08 20 07 20 06 20 05 20 04 20 03 20 02 20 01 20 00 0 19 99 Age-adjusted mortality rate from suicide per 100, 000 16 M Q SI

In the Bronx, males and non-Hispanic whites have the highest mortality rates from suicide 12. 5 Age-adjusted mortality rate from suicide per 100, 000 12 Firearm-related Other means 9. 4 7. 9 8 8. 5 8. 3 8. 9 11% 7. 1 6. 1 5. 0 4. 8 89% 4 2. 8 Nationwide, 50% of suicides are firearm-related 0 15 -24 21 25 -34 35 -44 45 -54 55 -64 65 -74 Male Female Hispanic NHB Data source: Underlying Cause of Death, 2015 -2017. Age specific rates not age-adjusted. NHW

In the Bronx, the mortality rate from suicide remains higher among males Male Female Age-adjusted mortality rate from suicide per 100, 000 12 10 8 10. 0 8. 9 6 4 2 1. 9 2. 3 0 2000 -01 22 2002 -03 2004 -05 Data source: Underlying Cause of Death, 2000 -2017. 2006 -07 2008 -09 2010 -11 2012 -13 2014 -15 2016 -17

In the Bronx, the mortality rate from suicide has remained relatively stable among Hispanic and non-Hispanic black residents, but increased among non-Hispanic white residents Hispanic Age-adjusted mortality rate from suicide per 100, 000 16 Non-Hispanic Black Non-Hispanic White 14 13. 4 12 10 10. 4 8 6 5. 2 4. 6 4 4. 0 3. 2 2 0 2000 -01 23 2002 -03 2004 -05 Data source: Underlying Cause of Death, 2000 -2017. 2006 -07 2008 -09 2010 -11 2012 -13 2014 -15 2016 -17

Non-Hispanic white males have higher mortality rates from suicide than Hispanic and non-Hispanic black males Male Age-adjusted mortality rate from suicide per 100, 000 20 Female 18 16 14 13. 7 13. 1 12. 5 12. 4 12 10 8 7. 9 7. 7 7. 0 5. 9 6 4. 2 4 2. 5 3. 4 3. 1 2. 2 2 1. 8 0 15 -24 24 25 -34 35 -44 45 -54 55 -64 65 -74 Data source: Underlying Cause of Death, 2010 -2017. Age specific rates not age-adjusted. Data unreliable for women 65 -74. Hispanic NHB NHW

The most common mechanism for suicide in the Bronx and the rest of NYC is suffocation, which includes hanging and strangulation Suffocation Fall Poisoning Firearm Cut/Pierce Drowning Other New York Staten Island Queens Manhattan Brooklyn Bronx 0% 25 20% 40% 60% 80% 100% Data source: Underlying Cause of Death, 2013 -2017. Other includes, for example, cut/pierce, fire/flame, hot object/substance, motor vehicle traffic, machinery, other transport, etc.

0 26 Lewis Delaware Oswego Sullivan Wyoming Allegany Cattaraugus Niagara Seneca Schoharie Essex Greene Columbia Jefferson Chautauqua Otsego Clinton Fulton Herkimer Steuben Washington Livingston Saratoga Cortland Madison Wayne Broome Chenango Tioga Montgomery Warren Franklin Rensselaer Tompkins Ulster Ontario Schenectady Oneida Dutchess Erie Genesee Onondaga Cayuga Chemung Albany Orleans St. Lawrence Monroe Suffolk Putnam New York Orange Westchester Nassau Rockland Richmond Queens Bronx Kings Age-adjusted suicide mortality rate per 100, 000 Among New York State counties, the Bronx has the second lowest suicide mortality rate 25 20 15 10 5 Data source: Underlying Cause of Death from CDC Wonder, 2012 -2017. Schuyler and Yates counties excluded because of unreliable estimates.

About the Community Health Dashboard Project § The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e. g. , by age, sex, race/ethnicity, etc. ) and sub-county/neighborhood level data § Will be periodically updated as new data becomes available. § Produced by Montefiore’s Office of Community & Population Health using publicly-available data sources § For more information please contact us at OCPHDept@montefiore. org 27